Dr. Katie Caldwell

Anything but Happy? You’re Not Alone.

“Happy holidays!” It’s a sentiment that so easily rolls off the tongue this time of year. Yet for many, myself included, “happy” isn’t the first word that comes to mind to describe this time of year. Christmas 2015 marked my family’s last “happy holidays.” Little did we know that six weeks later, my 17-year-old twin brothers would be killed in a devastating accident at Canada Olympic Park. Our lives were forever changed, and since then, the holidays have been tarnished with grief as we’ve faced the raw and palpable absence of Evan and Jordan in our lives.

Although grief remains ever-present, as time has passed, I’ve come to realize that other feelings have emerged for me this time of year—feelings of love, gratitude, reflection and strength. I’ve come to understand that "to grieve deeply is to have loved fully," and I feel so blessed to be surrounded by loved ones I can STILL hug tightly this holiday season.

Your holiday experience may be marked by different emotions, especially as we simultaneously navigate the challenging demands of residency. Maybe your Christmas table isn’t haunted by the same empty seats of lost loved ones but perhaps this year it’s YOUR seat that’s empty as you spend the holidays in the hospital caring for patients. Maybe you didn’t match to residency in a city close to your family and the holidays serve as a brutal reminder of that. You might feel isolated, angry, tired, unappreciated or burnt out. Whatever emotions you’re carrying this season, know that you’re not alone if you’re feeling anything but "happy."

Let’s Be Real… Block 7 Is Rough

“Just you wait. By Block 7, you’ll be burnt out and depressed.”

It was one of the only pieces of advice my senior resident gave me during my first block of residency. Landing dead in the middle of our dark and frigid winter, Block 7 marks the halfway point of our residency calendar year.

As the workhorses of a strained healthcare system, residents bear an even heavier load during this time of year. Viral season floods our wards with COPD exacerbations and other presentations of acute respiratory failure. Holiday indulgences exacerbate heart failure and tip people into decompensated cirrhosis. Substance use and family stressors fuel psychiatric emergencies. Patients with end-stage renal disease treat their dialysis runs around Christmas as "optional," and then nonchalantly show up to the ED with a potassium of 8. Traumatic injuries from MVCs on slippery roads and cases of severe frostbite in our unhoused population fill our ICU beds. Moral distress permeates every apology we feel compelled to offer patients on behalf of our broken system—for the interminable wait times, the lack of resources, and the indignity of being admitted to hallway beds.

We’re expected to be superhumans — regularly working 26-hour shifts without breaks, hopefully without mistakes and expected to bring our absolute best to every patient encounter. We’re reminded to be grateful if we get six consecutive days off this block. Meanwhile, we’re still required to cram seven 26-hour call shifts into 22 days instead of the usual 28, transforming our non-holiday schedule into a relentless cycle of call shifts every third day instead of every fourth.

Amidst all this, the personal stressors of the holiday season press on us too. My senior resident wasn’t wrong. Block 7 isn’t just rough — it’s a recipe for burnout. Our capacity is stretched beyond limits, and while we’re no strangers to hard work, this block tests even the strongest among us. We endure it, not because it’s sustainable, but because we have no choice. And if you’re feeling that strain, know this — you’re not alone.

Locus of Control

Medical training has taught me the importance of identifying what we can control and learning to cope with what we cannot. While much is out of our hands, there’s often more within our control than we realize. I urge you to find power in what you can control — starting with your attitude.

This isn’t about forcing yourself to be bright-eyed and bushy-tailed coming into work every day. It’s about recognizing the infectious power of your energy. Negativity breeds negativity while taking responsibility for the energy you bring to work can truly transform the culture of your workplace. Be affable, learn names and connect with co-residents, staff and allied health professionals alike. If you know me, you know I’m not one for superficial relationships. By intentionally building genuine connections with those we work alongside, we create an environment where extending grace becomes natural, blame is minimized and mistakes are seen as human rather than malicious.

Instead of stewing in frustration, channel it into action. For example, if the workstation computer doesn’t work, call IT and fix it. It’s not about toxic positivity — it’s about reclaiming agency where you can. As residents, we may not control how our staff or allied health treat us, but we hold power in how we react to them. We also have immense power in shaping how medical students and those more junior to us are treated. PLEASE, for the love of goodness, let’s break the toxic cycle of “I had it hard, so they should too.” Let it stop with you!

REFRAME

Yesterday, on my 28th hour awake, I was paged to pronounce the death of yet another C1 goals-of-care patient I had never met. Feeling like a zombie, I watched the snow blizzard furiously past the dark windows as I walked through the eerily quiet hallways from the Robbins Pavilion to the post-apocalyptic-feeling ATC building at the Royal Alex. Before stepping into the room to speak with the family at the bedside and declare time of death, I paused, took a deep breath and reframed the moment. What an immense honour it is, I thought, to be trusted to walk with patients and their families in their darkest hours, just as healthcare workers once did for mine. How fortunate am I to have a body and mind that is somehow capable of practicing medicine while severely sleep-deprived, and to do it all with as much empathy and professionalism as I can muster. Reframing doesn’t erase the challenges, but it reveals the beauty and strength within them.

Isolation in Moderation

Residency can be an inherently isolating experience. Long hours and demanding expectations at work can leave little energy for social engagement. Far from family, too busy or tired to connect, it’s easy to isolate and withdraw. As physicians, so many parts of our lifestyle — sleep deprivation, quick and easy highly processed diets, stress and long, inconsistent hours—are risk factors for poor health outcomes. Don’t let isolation be one more!

We see firsthand the morbidity and mortality associated with isolation and how it is a modifiable risk factor for cognitive decline, heart disease and mental health conditions. While we’re often told to eat better and exercise, the protective factor of social connection is often overlooked despite its immense benefits. In today’s hyper-connected digital world, it feels like we’ve never been further disconnected from one another, and loneliness has reached epidemic levels.

Introvert or not, I encourage you to fight the urge to withdraw. Exercise your social battery. Small efforts like making a call, grabbing a coffee with a co-resident or going to work out with a friend go a long way in building your community. I can assure you there are many amazing people around you longing for the same community you crave — you just have to take the first step. There is so much power in togetherness; stop trying to carry the weight of the world alone.

Protect Your Peace

Time and energy are our most valuable and limited resources as residents and they must be fiercely protected. This holiday season, I encourage you to reflect on the relationships in your life: Who gives you energy and who drains it? Have you been mistreated or disrespected by someone close? Are they willing to take responsibility or do they avoid accountability?

Healthcare often attracts people-pleasers who fear conflict and tolerate mistreatment for the illusion of peace. But pretending everything is fine only harms you!

Give yourself permission to have tough conversations and express your feelings. Set boundaries and learn to not tolerate mistreatment. It won’t be easy, but in the process, you’ll uncover authentic relationships and be drawn to people who make you a better version of yourself. You’ll find a truly supportive community that enriches your life with joy, purpose and renewed strength. Residency will take and take and take and if you’re not careful, people in your life will too. If you’re not intentional, you’ll look up one day and realize you’ve given everything away. Your energy and time are your most valuable assets and they deserve to be spent wisely. Not everything or everyone deserves access to them. Recognize what is draining you and what is refuelling you — then set boundaries and protect the latter at all costs.

Life and Identity Outside of Medicine

Wise words from a dear mentor of mine, Dr. Mel Lewis, have stuck with me since my first year of medical school: “The happiest and healthiest people in medicine are those with lives outside it.” At the time, during the heart of the pandemic, I had no life outside of studying medicine and I was deeply unhappy. It’s advice I’ve clung to and pushed myself to follow, finding what gives me identity and purpose outside of medicine.

One incredible outlet I’ve found has been the world of group fitness. Yesterday, I completed my 400th F45 group fitness class. It’s taken discipline, but the work-life synergy I’ve found has been so fulfilling. It’s a type of balance that a younger version of myself didn’t think was plausible. In my time off this year, I’ve also been fortunate to travel the world with friends—from Japan to Korea, Bali to Mexico, Portugal to Spain. I’ve embraced every opportunity to see the world that my brothers and I had only dreamed of seeing as kids. 

This holiday season, I encourage you to reconnect with who you are beyond your title as “doctor.” In medicine, many of us get caught in the "arrival fallacy" — the idea that "I’ll be happy when…". "I’ll be happy when I get the residency position I want." "I’ll be happy when residency is over and I pass my Royal College Exam." "I’ll be happy when I get the fellowship position I want." "I’ll be happy when I get my dream job as an attending at an academic center." In reality, it’s a recipe for discontentment.

One of the most challenging lessons I learned in medical school was how to live in the moment. I realized that I had become an anxious spectator of my own life, watching it unfold as though I were dissociated from it. I constantly counted down the days to the next big deadline, never fully present and let life slip by without truly engaging in it. This toxic coping mechanism, often born from trauma, serves as a form of self-protection — expecting the worst and focusing endlessly on the future. Over time, I’ve worked hard to break free of this pattern and learn to be present in the now. 

If this resonates with you, I encourage you to let go of the relentless grip of worrying about the future. We are not promised tomorrow!! Our lives are unfolding right now, even amidst the chaos of Block 7. We owe it to ourselves to reclaim the present moment — to find joy, nurture community and rediscover who we are in the here and now.

So this holiday season, I’m giving myself permission to feel it all — the grief, the gratitude and everything in between. I hope you’ll do the same. Happy (or not so happy) holidays!

Christmas 2015, our last holiday season with Evan and Jordan

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